By Marv Law, CLTC
With the enormous wave of information coming overwhelming Medicare beneficiaries, it is important to be aware of common mistakes made when choosing a plan. The following information answers questions I’m often asked as well as frequent misunderstandings I witness among many when selecting their Medicare options.
- Confusing Medicare Advantage plans with Medicare Supplements
Medicare Supplement plans are offered by private insurance companies to help pay for some or all of Medicare covered services that are not paid in full by Original Medicare Part A and B, such as deductibles and co-insurance. These plans allow access to any doctor that accepts Medicare and there are no referrals required. Premiums vary based on zip code, age, the level of benefits on the each plan, and although the plans are standardized by Medicare to offer the same benefits, the premiums often vary from company to company, so it can often be helpful to compare from time to time. In California, there is an open enrollment every year during ones birth month to switch to any Medicare Supplement plan of equal or lesser value, without having to answer any medical questions or qualifications. Current Medicare Supplement plans do not include prescription drug coverage and so a Part D plan must be added if prescription coverage is desired. Although drug coverage is voluntary, there is a penalty assessed and added to the cost of a Part D premium for each month that a Medicare Beneficiary did not have creditable prescription coverage.Medicare Advantage Plans are typically PPO and HMO plans offered by private companies. On these plans, payment for medical services is entirely assigned by Medicare to the Plan to pay, which manages all the parts, A, B and typically D for prescriptions. Access to doctors and other health providers are determined by the Plan’s Network. On a PPO, services can be used out of Network but for a higher cost. On an HMO the plan will not pay for any services out of the Network, accept for medical emergencies and unless otherwise authorized by the Plan. Except for certain circumstances creating a Special Enrollment Period, these plans can only be changed during the Annual Enrollment Period (AEP), October 15 to December 7, as well as with Part D Prescription Drug Plans. - Assuming your current plan remains the right option for you
Although premiums can increase annually with Medicare Supplements, the benefits do not change. However, benefits and costs often change on Medicare Advantage and Prescription Drug Plans. Also participating doctors can sometimes change. So it is often prudent to review your options periodically during an Annual Enrollment Period to determine if your plan is still the right plan for you.A licensed professional who is Certified with several Medicare Advantage Plans and appointed with many Companies offering Medicare Supplements is typically best able to provide objective advice and recommendations based on your specific needs and concerns. There is never a single company and plan that is right for everyone and these professional services can assist you in your research and are never any cost to you.